Toxic Docs Require Management Finesse

Sometimes, the situation is hopeless, and a know-it-all, bombastic physician won't try to change his attitude and outbursts. In those cases, the doctor has to be dismissed. But other physicians who act in a disruptive way may recognize trouble with their own behavior, have a desire to improve, and make a commitment to work vigorously for change.

That's why it is important to examine the root causes of disruptive behavior, understand the culture of medicine, and develop programs that could rehabilitate physicians from an organizational and individual perspective, says Hardley Paolini, PhD, LP, a licensed psychologist and director for Physician Support Services at Florida Hospital in Orlando.

Hospitals straddle the line in determining which physicians must be ousted after failing to respond to disciplinary action, and identifying those who can be rehabilitated. Making inroads in this improvement process can be a sensitive balancing act.

Too often, Paolini says, healthcare has not kept up to the challenge of disruptive physicians. "We have not trained our physicians for the resiliency they need, for the teamwork they need right now. When you see 40 to 60% of burned-out physicians, you are going to see some of these behaviors come out not only in depression, but also in aggression," she says.

Robert Fielder, MA (8/8/2013 at 4:46 PM)
The consequences of a disruptive physician's behavior can be among the most destructive to the effective delivery of medical services! Whatever the environment, behavior of this sort falls under the heading of workplace conflict and as other employers in other industries have repeatedly demonstrated, there's considerable benefit to be gained from implementing the full range of Dispute Resolution Techniques. Taken together, the various strategies and resources that can be deployed, in additional to those cited by Florida Hospital and DePaul University, constitute a Dispute Resolution System (DRS). A DRS can be locally designed and customized (usually by a multidisciplinary committee) at each hospital or practice. They are specifically designed to accommodate progressive discipline and incorporate coaching of and counseling with the offending individual. But [INVALID]ing the behavior is just the first step in the process. Effectively demonstrating to the offended individuals that such a change of heart has been accomplished requires that the offended individuals be involved in the search for effective resolution, as well. The participation of these fellow physicians or nurses, with the aid of peer or professional coaches, facilitators or mediators is the key to rebuilding the fractured relationships and that's the final step in the successful restoration of a functional healthcare team.